Authors' Response

We are in agreement that much of our practice is based on tradition and habit and may be improved upon. Thanks to Ball and Clark for their comments and, in particular, highlighting the important editorial by Davies¹ on this subject. Although in the study of Kojima et al.,² the observers were unblinded and had not used validated questionnaires to measure anxiety of patients, their study highlights that current practice may not be optimal in terms of patient satisfaction and use of resources. In the Davies¹ editorial on the subject of patients walking to the operating theatre, he highlights a model for the management of ‘change’ created by Prochaska, DiClementi and Norcross. This model highlights six stages (both behavioural and cognitive) required for a change to take place. The stages include precontemplation, contemplation, preparation, action, maintenance and relapse (if the new change is not satisfactory) or termination (if the new change is better than the old habit). It seems that on the subject of walking to the operating theatre, most hospital trusts may be ignorant of the advantages of changing current practice. We hope that our article has instituted a slight transformation by encouraging people to enter into contemplation on this subject. Most importantly, it has become clear that a very small change can have a profound impact on patient satisfaction and their overall experience of an operation. This may be in the form of a kind word, a smile or even having the choice to walk to their operation.